MedPsych Resident Rotation Overview

Welcome to the Medicine-Psychiatry Service!

During your rotation you will learn or expand your knowledge of the basic principles of evaluation and treatment of psychiatric conditions in medical-surgical outpatients. The information that follows should help you understand what you will be doing the next month and the expectations the faculty will have of you. Please review it carefully. If you have any questions or problems during the month, don't hesitate to ask Dr. Resch.

Rotation Supervisor:
David Resch, M.D.
Office: MMC - A497
Telephone: 545-4234

Start of Rotation:
Contact Dr. Resch one-week prior to start of the rotation.

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Objectives/Competencies:

Patient Care

Complete a complete and accurate medical/psychiatric evaluation including history, physical and mental status examination and collateral information. This evaluation should address the question or questions asked by patient or the referring/consulting physician.
Formulate an appropriately broad differential diagnosis that integrates DSM IV, biological, psychological, social and cultural factors, and identify the most likely diagnosis.
Have an understanding of the role of electroconvulsive therapy (ECT) in treating psychiatric disorders, including a working knowledge of the pre-operative assessment and management of patients undergoing ECT.

Medical Knowledge

Demonstrate a working knowledge of the pertinent data relevant to the condition(s) being evaluated . This working knowledge should include an understanding of the epidemiology, diagnostic criteria, natural history and treatment options for the following illnesses

Major depressive disorder
Generalized anxiety disorder
Panic disorder
Obsessive compulsive disorder
Acute delirium
Substance abuse/dependence
Somatoform disorders
Developmental disability
Schizophrenia

Demonstrate a working knowledge of the clinical presentation(s), evaluation and management of delirium
Know the epidemiology and risk factors for suicide, and be able to competently assess your patients' potential for suicide or violence
Have an understanding of common psychosocial factors in acute and chronic illness, including when to refer for psychotherapy

Practice-Based Learning and Improvement

Read about your patients
Identify deficiencies in your database. Be able to critically evaluate resources used to correct deficiencies.
Complete the Quality Improvement Project listed in the attached appendix

Interpersonal skills and Communication

Present a concise, accurate case presentation of the evaluated patient, both orally and in writing.
Communicate in a timely and effective manner with patients, team members, referring physicians and agencies.

Professionalism

Demonstrate professional behavior as evidenced by
Promptly dictating all notes (within 24 hours of evaluation)
Writing progress notes on all patients each day
Behavior consistent with the AMA Standards of Ethical Behavior for Physicians
Empathetically and respectfully interacting with all patients and staff
Reliably participating each (unless an excused absence is obtained)

Systems-Based Practice

Organize and teach when necessary, personnel to deliver appropriate intervention (including referring physician, patient's family or social agencies)
Residents are expected to read about the cases that they see. Recommended resources are at the end of this document. Discussions of readings and the QI project will be during the second week and fourth week of the rotation.

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Conferences (Mandatory) / Didactic Material:

Journal Club - Third Wednesday of each month starting at 12:00 pm until 1:00 pm. in room D443. On service residents will be expected to pick up and be ready to discuss an article from the division secretary in sufficient time prior to journal club. This activity takes priority over other activities of the service.

Medicine Grand Rounds - Every Tuesday at 8:00 AM

Grand Rounds are held in Wedeberg Conference Center, Memorial Medical Center or Bunn Auditorium, St. John's Hospital. Look for the weekly flier from the residency office for the location. This activity takes priority over other activities of the service.

Weekly Residency Conferences - Monday, Wednesday, Thursday, and Friday at 12:00 PM

These conferences are required by the Medicine Department for all residents. Plan to attend regularly. These conferences take priority over other activities of the service.

Didactic Material - Web based instructional materials are to be viewed and the corresponding evaluations of the presentations are to be completed by the end of the rotation. Access to this material will be through the WebCT site. You may request your access name and password from the division secretary.

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Call Schedule:
There is no overnight call for this rotation, unless the Department of Medicine assigns certain residents back-up call responsibilities.

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Days Off:
Typically every Saturday and Sunday is scheduled as a day off. If vacation time is scheduled during this rotation, Saturdays and Sundays are included in days requested off.

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Moonlighting:
Permitted with the approval of the rotation supervisor and under the policy of the Department of Internal Medicine.

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Vacation Time:
Per the Department of Internal Medicine policy, up to 12 days of vacation or educational leave (inclusive of weekend days) may be taken off during this rotation. If vacation time is scheduled during this rotation, Saturdays and Sundays are included in days requested off.

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Evaluation/Feedback:
Attending physicians will complete a resident performance evaluation form for each resident.

Faculty are expected to meet face-to-face with the resident at the end of the rotation to review the evaluation. The Department of Medicine's uniform residency evaluation form is used.

Residents will complete evaluations on each of the attendings and the rotation as a whole per department policy.

Relative breakdowns of the rotation will be as follows

Active participation in clinical activities (Will include the assessment and treatment of patients)	50%
Completion and presentation of QI project Successful completion of the Quality Improvement Project is necessary for this rotation. Failure to do so will be noted on the evaluation form under the professional behavior categories.	15%
Interpersonal interactions with patients and staff	20%
Successful completion of didactic material on WebCT	15%

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References Which May Be of Assistance to You:

Cassem, Ned H, Stern, Theodore, and Rosenbaum, Jerold, eds. Massachusetts General Hospital Handbook of General Hospital Psychiatry, 4th edition, 1997, Mosby Year Book Publishers.

Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, 1994, American Psychiatric Association, Washington, DC.

Kammerer, William S., Gross, Richard J. Medical Consultation: The Internist on Surgical, Obstetric, and Psychiatric Services, 3^rd edition, 1998, Williams & Wilkins.

Lipowski, Zbigniew J. Delirium: Acute Confusional States, 1990, Oxford University Press.

Rundell, James R. and Wise, Michael. Essentials of Consultation-Liaison Psychiatry: Based on the American Psychiatric Press Textbook of Consultation-Liasion Psychiatry, 1999, American Psychiatric Press.

Rundell, James R. and Wise, Michael. Textbook of Consultation-Liasion Psychiatry, 1996, American Psychiatric Press.

Stoudemire, Alan, ed. Human Behavior: An Introduction for Medical Students, 1998, Lippincott, Williams & Wilkins Publishers.

Stoudemire, Alan and Fogel, Barry, eds. Medical-Psychiatric Practice, Volume 1, 1991. American Psychiatric Press.

Stoudemire, Alan and Fogel, Barry, eds. Medical-Psychiatric Practice, Volume 2, 1993. American Psychiatric Press.

Stoudemire, Alan and Fogel, Barry, eds. Medical-Psychiatric Practice, Volume 3, 1995. American Psychiatric Press.

Stoudemire, Alan, Fogel, Barry, and Greenberg, Donna, eds. Psychiatric Care of the Medical Patient, 2^nd edition, 2000, Oxford University Press.

Strain, J. et al. Consultation-Liaison Psychiatry Database (2000 Update), 1999, General Hospital Psychiatry, 21(6): 401-502.

Journal Articles of Potential Benefit

Practice Guideline for the Treatment of Patients with Delirium, 1999, The American Journal of Psychiatry, 156:5 (supplement)

Practice Guideline for the Treatment of Patients with Major Depressive Disorder (Revision), 2000, The American Journal of Psychiatry, 157, 4 (Supplement).

Practice Guideline for the Treatment of Patients with Nicotine Dependence, 1996, The American Journal of Psychiatry, 153 (Supplement).

Practice Guideline for Psychiatric Evaluation of Adults, 1995, The American Journal of Psychiatry, 152 (Supplement): 63a-80a.

Practice Guideline for the Treatment of Patients with Substance Use Disorders: Alcohol, Cocaine, Opioids, 1995, The American Journal of Psychiatry, 152 (Supplement): 1a-59a.

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